Health Disparities Among Kinky Sex Practitioners
Purpose of review
This review is to characterize the theoretical and empirical literature about alternative sexual behaviors, predominantly known under the umbrella of bondage and discipline, dominance and submission, and sadism and masochism (BDSM, also known as “kink”). The overview is to aid the clinician in understanding how particular studies might fit into the larger context of the scholarly and empirical literature in order to judge the generalizability of conclusions. The specific concern of whether there are health disparities for this stigmatized sexuality is considered and explored.
The literature contains a wide range of positions and perspectives, ranging from always pathologizing BDSM behavior to proposing therapeutic functions of BDSM behavior. There are significant differences across professions in treatment of BDSM, and the medical literature is noted for being disorganized and piecemeal and starting to change over the past 5 years in ways that addresses the earlier problematic approaches that may have hindered clinical practice.
Empirical evidence suggests significant stigma impacting the health of BDSM-identified patients and impacting the healthcare service provided to kinky sex practitioners. The empirical and scholarly literature about BDSM or kink demonstrates a trend that addresses the stigma of alternative sexualities, but more work is needed.
KeywordsBDSM Health disparities Mental health Sexual minority
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflicts of interest.
Human and Animal Rights and Informed Consent
All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.Ortmann D, Sprott R. Sexual outsiders: understanding BDSM sexualities and communities. New York: Rowman and Littlefield; 2012.Google Scholar
- 2.•• Joyal CC, Carpentier J. The prevalence of paraphilic interests and behaviors in the general population: a provincial survey. J Sex Res. 2016;1–11. doi: 10.1080/00224499.2016.1139034. This study examines rates of interest and participation in a range of behaviors that are classified as paraphilias, in a population based sample.
- 4.Kleinplatz PJ, Moser C. Sadomasochism: powerful pleasures. New York: Harrington Park Press; 2006.Google Scholar
- 5.•• Waldura JF, Arora I, Randall AM, Farala JP, Sprott RA. Fifty shades of stigma: exploring the health care experiences of kink-oriented patients. J Sex Med. 2016;13(12):1918–29. doi: 10.1016/j.jsxm.2016.09.019. This study reports on issues of stigma in healthcare settings for kink-oriented patients.CrossRefPubMedGoogle Scholar
- 6.• Sprott RA, Randall AM, Davison K, Cannon N, Witherspoon R. Alternative or non-traditional sexualities and therapy: a case report. J Clin Psychol. 2017 In Session. This case presentation explores issues of stigma in psychotherapeutic contexts and demonstrates competent care strategies.Google Scholar
- 7.Bienvenu RV, Wynn G. BDSM subcultures and academic literatures addressing BDSM: an overview for clinicians and researchers. Presented at Leather/Kink/BDSM sexuality—cultural competence and clinical issues. Chicago: 22 May 2008.Google Scholar
- 8.•• Pascoal PM, Cardoso D, Henriques R. Sexual satisfaction and distress in sexual functioning in a sample of the BDSM community: a comparison study between BDSM and non-BDSM contexts. J Sex Med. 2015;12(4):1052–61. This study reports on the sexual health of kink-oriented people, one of the first studies to do so.CrossRefPubMedGoogle Scholar
- 9.• Rehor JE. Sensual, erotic, and sexual behaviors of women from the “kink” community. Arch Sex Behav. 2015;44:825–36. This study reports on a wide range of behaviors and activities that gives the clinician an idea of what behaviors might be under the umbrella term of BDSM.CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Fischer J, Gochros HL. General procedures: handbook of behavior therapy with sexual problems, Volume 1 health & fitness; 2013.Google Scholar
- 16.Shahbaz C, Chirinos P. Becoming a kink aware therapist. New York: Routledge; 2016.Google Scholar
- 17.Plouffe R, Saklofske DH, Smith M. The development and validation of a “dark tetrad” measure of personality. Personal Individ Differ. 2016;101:505.Google Scholar
- 25.National Coalition for Sexual Freedom. NCSF violence and discrimination survey. 2008. Retrieved from https://ncsfreedom.org/resources/bdsm-survey.html.
- 26.Moser C. Health care without shame. San Francisco: Greenery Press; 1999.Google Scholar
- 28.Glyde T. BDSM: psychotherapy’s grey area. Lancet March. 2015;2:211–3.Google Scholar
- 30.• Sprott RA, Randall AM. The health and healthcare experiences of kink-oriented people: 2016 survey results. November 2016 meeting of the society for the scientific study of sexuality, Phoenix AZ. 2016. This study is the first of its kind to report on the overall health status of a large kink-oriented sample.Google Scholar
- 31.•• Roush JF, Brown SL, Mitchell SM, Cukrowicz KC. Shame, guilt, and suicide ideation among bondage and discipline, dominance and submission and sadomasochism practitioners: examining the role of the interpersonal theory of suicide. Suicide Life Threat Behav. 2017;47(2):129–41. This study presents an in-depth examination of the mental health status of the kink-oriented population, the first of its kind to report specifically on suicidality.CrossRefPubMedGoogle Scholar
- 34.Bruce D, Harper GW, Bauermeister JA. Minority stress, positive identity development, and depressive symptoms: implications for resilience among sexual minority male youth. Psychol Sex Orientat Pend Divers. 2015;2(3):287–96.Google Scholar